Supreme Court May Hand Back Billions of Dollars to Self-insured Plans On BCBS Appeals – ERISAclaim.com Demystifies

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On Sep 15, 2014, in Supreme Court (SC), Blue Cross Blue Shield Association, et al. filed an Amici Curiae Brief in support of BCBSM, appealing a Sixth Circuit Court award of $6.1 million to a self-insured plan. ERISAclaim.com demystifies that a SC decision may hand back billions of dollars to all self-insured plans.

“If Supreme Court upholds the Sixth Circuit decision of $6.1 million award for just one self-insured plan, the immediate impact would be billions of dollars for all self-insured ERISA plans," says Dr. Jin Zhou

On Sep 15, 2014, in Supreme Court (SC), Blue Cross Blue Shield Association, et al. filed an Amici Curiae Brief in support of Blue Cross Blue Shield of Michigan (BCBSM), appealing a Sixth Circuit Court decision upholding a district court award of $6.1 million for a self-insured plan against BCBSM, as a third party claim administrator (TPA), for violating ERISA's prohibition against self-dealing and breaching its fiduciary duties as well as engaging in fraud and concealment to hide its violations from plaintiffs. ERISAclaim.com demystifies that a Supreme Court decision may hand back billions of dollars to all self-insured plans on BCBS appeals.

ERISAclaim.com announced new advanced ERISA Embezzlement Recovery Programs in preparation of the forth-coming Supreme Court decision with multi-billion dollar impact for all self-insured health plans on whether: (1) over billions of dollars of the successful TPA overpayment recoupment and offset nationwide each year are ERISA plan assets, (2) all TPA’s must refund all ERISA plan assets as ERISA prohibits all self-dealings, (3) all self-insured plan administrators are liable for fiduciary breach in failing to safeguard or recover plan assets. Therefore, it’s extremely critical for all self-insured health plans and TPAs’ to watch for this Supreme Court decision on BCBS appeals.

“If Supreme Court upholds the Sixth Circuit decision of $6.1 million award for just one self-insured plan, the immediate impact would be billions of dollars for all self-insured ERISA plans, in a time when the TPAs industry has potentially recovered more than billions of dollars in overpayment recoupment and anti-fraud campaigns in the past 10 years,” says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on ERISA appeals and compliance.

“For more than 6 years, ERISAclaim.com has been dedicated to ERISA plan assets audit and embezzlement recovery education and consulting. Now with Supreme Court guidance on ERISA anti-fraud protection, we are ready to assist all self-insured plans to recover billions of dollars for all hard-working Americans,” says Dr. Zhou.

Supreme Court Case Info:
Case No. 14-168, Title: Blue Cross Blue Shield of Michigan, Petitioner v. Hi-Lex Controls, Inc., et al., Docketed: August 14, 2014, Lower Ct: United States Court of Appeals for the Sixth Circuit, Case Nos.: (13-1773, 13-1859), Decision Date: May 14, 2014

http://www.supremecourt.gov/Search.aspx?FileName=/docketfiles/14-168.htm

http://www.ahip.org/BCBSMIHiLex9152014/

http://www.ca6.uscourts.gov/opinions.pdf/14a0100p-06.pdf

In Supreme Court, on Aug 12, 2014, BCBSM filed a Petition for a writ of certiorari, asking high court to reverse a Sixth Circuit Court decision upholding a district court award of $6.1 million for a self-insured plan for fiduciary breach and ERISA fraud in concealing hidden fees as a TPA to Hi-Lex, a self-insured plan.

On Sep 15, 2014, an Amici Curiae Brief in support of BCBSM was filed by Blue Cross Blue Shield Association, America’s Health Insurance Plans, and Pharmaceutical Care Management Association, arguing “(I) the court of appeals’ decision creates uncertainty about when a third-party administrator is exercising control over plan assets”, and “(II) the court of appeals has created the specter that all third-party administrators could be deemed ERISA fiduciaries”, according to the court document.

BCBSA et al specifically argued: “In short, the determination as to whether an entity is an ERISA fiduciary is an important question with far-reaching ramifications that, in the context of the Sixth Circuit’s incorrect and aberrational decision, warrants this Court’s review. Review of that decision would ensure that the decision does not result in an ill-considered expansion of fiduciary litigation and liability for potentially thousands of ERISA plans covering millions of participants and billions in plan assets.” according to the court document. (Supreme Court Case No. 14-168, Title: Blue Cross Blue Shield of Michigan, Petitioner v. Hi-Lex Controls, Inc., et al., Docketed: Sep 15, 2014)

On May 14, 2014, in Hi-Lex Controls, Inc. v. Blue Cross Blue Shield of Michigan, 2014 WL 1910554, a federal appeals court (Sixth Cir. 2014) upheld a district court’s $6.1 million decision for Hi-Lex, a self-insured ERISA plan against BCBSM for violating ERISA in prohibited transactions and fiduciary fraud. Sixth Cir. concludes that (1) BCBSM served as a fiduciary for self-insured because it held or controlled plan assets and exercised authority over covered assets; (2) the Hi-Lex complaint was not time-barred because BCBSM’s actions triggered ERISA six-year fraud and concealment statute of limitations; and (3) BCBSM’s use of fees by self-paying it discretionarily charged for its own account is exactly the sort of self-dealing that ERISA prohibits fiduciaries from engaging in, according to the court document. (Sixth Circuit, Case Nos.: (13-1773, 13-1859), Decision Date: May 14, 2014)

The district court awarded Hi-Lex over $5 million in damages and prejudgment interest of almost $914,241. According to Hi-Lex’s allegations, BCBSM misrepresented and intentionally concealed these additional fees in contract documents and assured Hi-Lex that no fees were charged other than the administrative fee. Upon learning about the additional fees, Hi-Lex sued, claiming that BSBSM violated ERISA by engaging in self-dealing, according to the court document. (Sixth Circuit, Case Nos.: (13-1773, 13-1859), Decision Date: May 14, 2014)

To find out more about ERISAclaim.com’s Overpayment Recoupment and Embezzlement Recovery Services (ORERS): http://erisaclaim.com/Embezzlement_Recovery.htm

Located in a Chicago suburb in Illinois, for over 15 years, ERISAclaim.com is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country. ERISAclaim.com offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as numerous pending national ERISA class action litigation support. Dr. Jin Zhou is regarded as the industry “Godfather of ERISA claims” for healthcare providers, the unique knowledge and experience for overpayment plan assets recovery.

For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.

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ERISAclaim.com
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